Clinical study
Complications of surgery in hypothyroid patients

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Abstract

Hypothyroidism has generally been considered a contraindication to surgery. To determine the actual risks of perioperative complications in hypothyroid patients, the clinical courses of 40 hypothyroid surgical patients (serum thyroxine concentration 1.9 ± 1.0 μg/dl) were retrospectively compared with those of 80 control patients matched for age, sex, and operative procedure. The two study groups were comparable in preoperative anesthetic physical class, prevalence of other medical conditions, and year of operation. During noncardiac surgery, intraoperative hypotension was encountered more frequently in the hypothyroid patients than in the control patients (61 versus 30 percent, p < 0.05). Cardiac surgery was complicated by heart failure more often in the hypothyroid patients (29 versus 6 percent, p < 0.05). Postoperatively, the hypothyroid patients more commonly had gastrointestinal (19 versus 1 percent, p < 0.02) and neuropsychiatric (38 versus 18 percent, p < 0.02) complications than control patients. Despite comparable rates of perioperative infection (38 versus 33 percent, p = NS), the hypothyroid patients less frequently manifested fever (35 versus 79 percent, p < 0.001). There were no differences in perioperative blood loss, duration of hospitalization, or the prevalences of perioperative arrhythmia, hypothermia, hyponatremia, delayed anesthetic recovery, abnormal tissue integrity, impaired wound healing, pulmonary complications, or death. Preoperative clinical and chemical features of hypothyroidism were not useful in defining a subgroup of patients at special risk. Thus, surgery in hypothyroid patients is associated with an increased risk of several minor perioperative complications, which should be anticipated and preemptively managed in the course of their anesthetic and surgical care.

References (27)

  • FR DeRubertis et al.

    Impaired water excretion in myxedema

    Am J Med

    (1971)
  • TD Paine et al.

    Coronary arterial surgery in patients with incapacitating angina pectoris and myxedema

    Am J Cardiol

    (1977)
  • SI Schwartz et al.

    Thyroid and parathyroid

  • PH Forsham

    Special medical problems in surgical patients

  • GB Bulkley et al.

    Perioperative care

  • JM Murkin

    Anesthesia and hypothyroidism: a review of thyroxine physiology, pharmacology, and anesthetic implications

    Anesth Analg (Cleve)

    (1982)
  • AR Boutrous

    Anesthesia and the thyroid gland: a review

    Can Anaesth Soc J

    (1961)
  • ML James

    Endocrine disease and anaesthesia

    Anesth Analg (Cleve)

    (1970)
  • RA Buccino et al.

    Influence of the thyroid state on the intrinsic contractile properties and energy stores of the myocardium

    J Clin Invest

    (1967)
  • WF Crowley et al.

    Noninvasive evaluation of cardiac function in hypothyroidism

    N Engl J Med

    (1977)
  • JS Graettinger et al.

    A correlation of clinical and hemodynamic studies in patients with hypothyroidism

    J Clin Invest

    (1958)
  • CW Zwillich et al.

    Ventilatory control in myxedema and hypothyroidism

    N Engl J Med

    (1975)
  • JW Swanson et al.

    Neurologic aspects of thyroid dysfunction

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    This work was supported in part by U.S. Public Health Service Grant AM-16791. Dr. Ladenson is a Teaching and Research Scholar of the American College of Physicians.

    1

    From the Thyroid Unit, Medical Services, Massachusetts General Hospital, Boston, Massachusetts.

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